A 20-year audit from 2000 to 2020 of the management and treatment outcomes of temporomandibular joint ankylosis among a cohort of patients at Wits Oral Health Centre

Abstract

Background: Temporomandibular joint ankylosis (TMJA) is a pathologic condition characterised by fusion of the condyle to the fossa by bony or fibrotic tissue. The severity of the condition depends of the age of onset and whether it is unilateral or bilateral. The aim of this study was to report on management and outcomes of patients with TMJA in our unit. Method: A retrospective analysis of the demographic, risk factors, clinical presentation, treatment modalities and outcomes of patients treated in the department of Maxillofacial and Oral Surgery from January 2000 to December 2020, at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Chris Hani Baragwaneth Academic Hospital (CHBAH), University of the Witwatersrand. Results: The study included 71 cases. The age ranged from 4 years to 70 years. 49.3% (n=35) of the patients were female, while 50.7% (n=36) were male. Majority of patients (39.44%) (n=28) presented with left TMJ ankylosis, followed by right TMJ ankylosis (38.03%) (27) and bilateral TMJ ankylosis (22.54%) (n=15). Trauma was found to be the leading cause of TMJ ankylosis at 77.46% (n=55) while the cause of ankylosis in 18.31% (13) of patients was unknown and 4.23% (n=3) was caused by infection. The treatment modalities were Gap Arthroplasty, Costochondral Graft and Total Alloplastic Joint Reconstruction. Majority of patients 57,75% (n=41) had isolated GAP as the treatment modality, followed by 26.76% (n=19) who had TAJR, and 15.49% (n=11) who had CCG. Six of the nine patients who had recurrent ankylosis were treated by CCG. Conclusion: Data analysed in this study indicate that trauma is the leading cause of TMJ ankylosis. From the findings of the present study, revealing no difference between GAP, CCG and alloplastic joint reconstruction, we conclude that irrespective of the treatment modality executed, early surgical intervention, radical and sufficient resection of ankylosed mass, early postoperative exercises, active physiotherapy and follow-up are imperative for successful rehabilitation and prevention of reankylosis of patients with temporomandibular joint ankylosis.